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Regional Report on Status of RoadSafety: the South-East Asia Region

A Call for Policy Direction


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World Health Organization 2009

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WHO Library Cataloguing-in-Publication data

World Health Organization, Regional Ofce for South-East Asia.Regional report on status of road safety: the South-East Asia Region.

1. Accidents, Trafc - prevention and control. 2. Automobile Driving - legislation and jurisprudence

education. 3. Alcohol Drinking 4. Head Protective Devices - utilization. 5. Safety. 6. Data

Collection - statistics and numerical data.

ISBN 978-92-9022-355-9 (NLM classication: WA 275)


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A Call for Policy Direction iii

Contents

Preface................................................................................................................... v

Executive summary ............................................................................................ vii

Acknowledgements .............................................................................................. x

Background1. .................................................................................................... 1

Road trafc injury prevention efforts .............................................................................5

The need for situation analysis2. .................................................................... 9

Road trafc injury scenario3. ........................................................................ 13

Road trafc injuries: An epidemic in the Region .........................................................13

Vulnerable road users .................................................................................................17

Data on economic cost ...............................................................................................18

Registered vehicles .....................................................................................................19

Safety law exists but the level of implementation is suboptimal .................................21

Speed ...................................................................................................................21

Alcohol ..................................................................................................................23

Helmets .................................................................................................................26

Seat-belts and child restraints ...............................................................................29

Synopsis of legislative issues .....................................................................................31

Pre-hospital care system ............................................................................................31

All participating countries have the institutional framework

for road trafc injury prevention ..................................................................................33

Other measures to reduce exposure and prevent road trafc injuries ........................34

Conclusions and recommendations4. .......................................................... 37

Main messages from the Report .................................................................................39

Recommended actions ...............................................................................................40

References .......................................................................................................... 44

Explanatory notes for Statistical Annex ........................................................... 46

Background .................................................................................................................46

Data processing ..........................................................................................................46

Reporting of country-level data ...................................................................................46

Types of data utilized ..................................................................................................47

Reported data .............................................................................................................47

Adjusted data ..............................................................................................................47

Modelled data .............................................................................................................47

Estimation method ......................................................................................................48

References..................................................................................................................50


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Regional Report on Status of Road Safety: the South-East Asia Regioniv

Country proles.................................................................................................. 59

Bangladesh .................................................................................................................64

Bhutan.........................................................................................................................68

India ............................................................................................................................72

Indonesia ....................................................................................................................76

Maldives ......................................................................................................................80

Myanmar.....................................................................................................................84

Nepal...........................................................................................................................88

Sri Lanka .....................................................................................................................92

Thailand ......................................................................................................................96

Timor-Leste ...............................................................................................................100


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A Call for Policy Direction v

Preface

Over the last few decades there have

been fundamental changes in disease

patterns among the people of Member

States of the WHO South-East Asia Region

due to rapid urbanization and economic

growth. The pattern of mortality and

morbidity with regard to communicable

and noncommunicable diseases in theseMember States has changed. From being

largely linked to infectious diseases earlier, it is now mainly related to

noncommunicable diseases as well as injuries and violence. Road traffic

injuries have emerged as one of the leading causes of death and disability

in most countries of the Region.

The Regional Report on Status of Road Safety: the South-East Asia

Regionprovides an opportunity to depict the extent and scale of this particular

problem. Road traffic injuries are one of the fastest growing epidemics in the

South-East Asia Region, and more than 285 000 people are dying on the

roads every year. The trend in road traffic deaths in most Member States of

the Region has also been on an upward spiral in recent years.

Historically, most of those killed on the roads in accidents are young and

aged between 15 and 44 years, thus corresponding to the most economically

productive segment of the population. Hence, road traffic injuries lead to

a colossal economic burden at both the family and community levels on

Member States of the Region.

The report reveals that almost three quarters of all road traffic deaths in

South-East Asia occur among the most vulnerable road users, i.e., pedestrians,

motorcyclists and cyclists. This report also reaffirms our understating of the

rapid growth of two- and three-wheelers in the Region, which is a major risk

factor in road traffic injuries. These two critical issues should be prioritized

during policy decisions on road safety.


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Regional Report on Status of Road Safety: the South-East Asia Regionvi

Although primary prevention is a far better option to address the huge

toll from road traffic injuries than other measures, only a few Member States

in the Region have specific preventive measures on road traffic injuries in

place. Measures that will reduce injuries and contribute to a healthier future

may include appropriate land use planning, setting safety standards for

vehicles, designing infrastructure keeping the protection of pedestrians and

motorcyclists in mind, promoting safe public transport, and campaigning for

the improvement of personal behaviour on roads. To realize this goal and

implement these measures it is imperative to develop and sustain strong

intersectoral partnerships and collaboration.

This is the first report published on the status of road safety in Member

States of the South-East Asia Region. This report provides policy-makers

and public health practitioners in the Region with a set of recommendationsfor the development of interventions to prevent avoidable deaths and injuries

from road traffic accidents. I trust this report will provide the necessary

impetus as well as serve as a benchmark for developing policy directions

on road safety in the Region.

Dr Samlee PlianbangchangRegional Director


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A Call for Policy Direction vii

Executive summary

Introduction: Road trafc injuries kill nearly 1.3 million women, men and

children around the world every year and are responsible for hundreds of

thousands of injuries and disability. World Health Organization estimates

predict that road trafc injury will increase from being the ninth leading cause

of death globally in 2004 to be the fth leading cause of death by 2030. In

2004, road trafc injury was the tenth leading cause of death in the WHO

South-East Region and was responsible for 2% of all causes of mortality.

Need for situation analysis: To address the huge burden of road trafcinjuries the World Report on Road Trafc Injury Prevention was launched in

2004. Following the launch, several resolutions have been adopted by the UN

General Assembly and one by the World Health Assembly which endorsed

the recommendations of the Report. Consequently, a number of countries

have taken positive steps to begin to address their road safety problem.

As more countries begin to take these steps it has become apparent that

regular global as well as regional assessments of road safety are needed

to improve road safety status.

Methodology: A self-administered questionnaire was developed by

WHO using the recommendations of the World Report on Road Trafc Injury

Prevention as the basis for its structure and content to gather information

on the status of road safety. Data from the participating countries of the

South-East Asia Region were collected using the global questionnaire. In

each participating country a National Data Coordinator coordinated the data

collection process, facilitated the consensus meeting for developing nal

country data set, entered the country data into the database set up for this

project, and obtained approval from the relevant government authority forusing country data in the global as well regional report. Ten countries (all

Member States of the Region except DPR Korea) participated in the survey.

All data were compiled and analysed by WHO headquarters (HQ) at the

central level. To avoid denition-related bias, modelled data for deaths were

considered to estimate the magnitude of the problem. The WHO Regional

Ofce for South-East Asia (WHO SEARO) also compiled regional data and

performed sub-analysis of data in the regional context.


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Regional Report on Status of Road Safety: the South-East Asia Regionviii

Findings: All participating countries have a national framework for

addressing road trafc injuries. Funding is available for the lead agencies to

carry out road safety activities in seven participating countries. This survey

found that approximately 288 768 people were killed in 2007 on the roads in

10 of the 11 countries that make up the WHO South-East Asia Region. The

highest mortality rates per 100 000 population were observed in Thailand

(25.4), Myanmar (23.4) and the Maldives (18.3). An upward trend in road

trafc deaths has also been observed in most participating countries of the

Region. It was found that males were almost three times more likely to be

victims of road trafc deaths than females. Almost three quarters of road

trafc deaths are among vulnerable road-users (pedestrians, motorcyclists

and cyclists). It was evident from the survey that motorized two- and three-

wheeled vehicles constituted more than 60% of the registered vehicles in

all participating countries of the Region except for Bhutan.

All the participating countries reported at least one law related to the

ve major risk factors (speed, drink-driving, helmets, seat-belts and child

restraints) at the national or sub-national level, although these are not all

comprehensive in scope. Existing laws appear to be inadequately enforced

in most of the countries. Only four participating countries have a formal

publicity mechanism in place at national level on the pre-hospital care system

and few participating countries have enforced different measures to reduce

exposure and prevent road trafc injuries.

Conclusion and recommendations: This report gives us, for the rst

time, a detailed assessment of the magnitude of road trafc injuries as

well as the existence of related institutions, policies, legislation and data-

collection systems, and perceived levels of enforcement of legislation at the

country level in the South-East Asia Region. During the last couple of years

an increase in road safety awareness has been observed in a few Member

countries of the Region. However, the ndings of this Regional Status Report

show that much more needs to be done. To reduce the toll of road trafcinjuries in the South-East Asia Region, governments and others involved in

road safety activity are encouraged to consider the key recommendations

of this Report, which are:

Strengthen lead agencies with authority, status and resources to1.

guide, develop, coordinate, implement and evaluate road safety is-

sues, policies and programmes.


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A Call for Policy Direction ix

Develop strategic guidelines for road trafc injury prevention with2.

specic measurable targets.

Develop and implement specic actions to prevent road trafc inju-3.

ries, such as:speed control on all arterial roads, urban and intercity areas(a)

and national highways; trafc calming in all urban roads and

on highways outside the urban areas; and enforcing a speed

limit of


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Regional Report on Status of Road Safety: the South-East Asia Regionx

Acknowledgements

This publication has been prepared by the World Health Organizations

Regional Ofce for the South-East Asia as part of a global initiative for road

trafc injury prevention.

Invaluable inputs for collection of country-level data for this Report were

made by the WHO Representatives and staff in Member countries, the

National Data Coordinators (Table B.1 in Statistical Annex) and all respondents

(Table B.2 in Statistical Annex). The cooperation of all government ofcialsconcerned in endorsing the information for inclusion in the Report is gratefully

acknowledged.

The Report also beneted from the contributions of a number of people.

In particular, Dr Witaya Chadbunchachai who reviewed the report and Prof.

Md. Shamsul Hoque (Accident Research Institute), Mr Harman Singh Sidhu

(AriveSafe, India), Dr Zaw Wai Soe (Yangon General Hospital, Myanmar)

and Ms Suchada Gerdmongkolgan (Ministry of Public Health, Thailand) who

provided the photograph.

Several WHO staff at both WHO/SEARO and WHO/HQ were involved in

data management (compiling, cleaning, validating and analyzing), in drafting

the report and reviewing it. Their inputs are greatly appreciated.

Finally, the WHO Regional Ofce for South-East Asia thanks Bloomberg

Philanthropies for its generous nancial support for the development and

publication of this Report.


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A Call for Policy Direction 1

Worldwide, there is consensus that low-

income and middle-income countries

are passing through an epidemiological

transition. The pattern of mortality

and morbidity in these countries is

changing from infectious diseases to

noncommunicable diseases as well

as injuries and violence. The World

Health Organization (WHO) estimates

that every day around the world

almost 16 000 people die from injuries

and violence, and that this accounted

for 9.8% of the worlds deaths and

Background 112.3% of the worlds burden of

disease1 in 2004. In particular, injuries

and violence accounted for 17% of

the disease burden among adults

aged 1559 years in 2004(1).

Road trafc crashes cause many

severe injuries and a large number of

deaths each year and, therefore, road

1 Burden of disease, the time-based

measure, combines years of life lost due topremature mortality and years of life lost due

to time lived in states of less than full health

(disability).


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Regional Report on Status of Road Safety: the South-East Asia Region2

trafc injuries are increasing being

recognized as an important public

health problem. They claim the lives

of nearly 1.3 million women, men and

children around the world every year

and are responsible for hundreds of

thousands of injury and disability.

The situation is particularly acute

in low-income and middle-income

countries which account for more than

90% of such deathsdespite these

countries owning less than half of all

motor vehicles(2). The Global Burdenof Disease Study (2004 update)

showed that in 2004, road traffic

injuries was the worlds ninth most

important health problem(3). World

Health Organization estimates predict

that road trafc injury will increase

from being the ninth leading cause

of death in 2004 to the fth leading

cause in 2030 (Table 1) (3). This is

mainly due to the increasing number

of road trafc crashes in low-income

and middle-income countries. It is

becoming increasingly evident that

poor and vulnerable groups in low-


have a disproportionate share of

the burden arising from road trafc

injuries(4). Although the epidemic

of road trafc injuries in low-income

and middle-income countries is still in

its early stages, it threatens to grow

exponentially unless swift action is

taken to counter it(5).


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Table 1: Leading causes of death in 2004 and 2030 compared(global scenario)

Rank2004

Disease or injury

As %

totaldeaths

Rank2030

Disease or injury

As %

totaldeaths

1 Ischaemic heart disease 12.2 1 Ischaemic heart disease 14.2

2 Cerebrovascular disease 9.7 2 Cerebrovascular disease 12.1

3 Lower respiratory infections 7.0 3Chronic obstructivepulmonary disease

8.6

4Chronic obstructivepulmonary disease

5.1 4 Lower respiratory infections 3.8

5 Diarrhoeal diseases 3.6 5 Road trafc injuries 3.6

6 HIV/AIDS 3.5 6Trachea, bronchus, lungcancers

3.4

7 Tuberculosis 2.5 7 Diabetes mellitus 3.3

8Trachea, bronchus, lungcancers

2.3 8 Hypertensive heart disease 2.1

9 Road trafc injuries 2.2 9 Stomach cancer 1.9

10Prematurity and low-birthweight

2.0 10 HIV/AIDS 1.8

11

Neonatal infections and

othera 1.9 11 Nephritis and nephrosis 1.612 Diabetes mellitus 1.9 12 Self-inicted injuries 1.5

13 Malaria 1.7 13 Liver cancer 1.4

14 Hypertensive heart disease 1.7 14 Colon and rectum cancer 1.4

15Birth asphyxia and birthtrauma

1.5 15 Oesophagus cancer 1.3

16 Self-inicted injuries 1.4 16 Violence 1.2

17 Stomach cancer 1.4 17Alzheimers and otherdementias

1.2

18 Cirrhosis of the liver 1.3 18 Cirrhosis of the liver 1.219 Nephritis and nephrosis 1.3 19 Breast cancer 1.1

20 Colon and rectum cancer 1.1 20 Tuberculosis 1.0

a This category also includes severe neonatal infections and other non-infectious causes arising inthe perinatal period apart from prematurity, low birth weight, birth trauma and asphyxia.


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The cost of road trafc injuries is

enormoushaving been estimated

at US$ 518 billion each year. This

is approximately 1% to 1.5% of the

gross domestic product (GDP) in low-


and around 2% in high-income

countries(6). Though only one person

may be involved in a road trafc crash,

the entire household can be affected

nancially, socially and emotionally.

Impacts include direct costs such as

medical and funeral costs as well as

indirect costs such as loss of work

time. Crash victims are often working-

age adults, whose families are then

left without a breadwinner or bear

the added expenses of caring for a

disabled family member (Box 1).

Box 1: Cost of road trafc injuries in Bangladesh

A study in Bangladesh found that 70% of families experienced a decline in householdincome and food consumption after the death of their family member in a road trafc

accident. Victims and their family members frequently experience depression, travel-related anxiety and sleep disturbance for years after a crash.

The study also estimated the national cost of road trafc crashes including property

damage, administration, lost output, medical and human costs which is estimated Taka

38 billion (US$ 644 million) per year. This is 1.5% of GDP and three times the annual

expenditure of the roads and highways department. However, even these costs areconsidered conservative because the study did not take into consideration: (a) the

number and cost of those permanently disabled; (b) travel time lost due to road trafc

crashes; and (c) the value of prevention, i.e. how much the general public would bewilling to spend in order to reduce the risk of road trafc crashes.

Source: Silcock B R. Guidelines for estimating the cost of road crashes in developing countries. London,Department for International Development, 2003 (Transport Research Laboratory Project R7780).

Road trafc injuries are one of

the fastest growing epidemics in the

South-East Asia Region.

Every hour 40 people in theRegion die as a result of a

collision. It is estimated that

306 000 people were killed

on the roads of countries of

the South-East Asia Region

in 2004(1).

The burden of road trafc injuries

has been rising rapidly in the South-

East Asia as countries increasingly

motorize. According to The Global

Burden of Disease Study

(2004 update)(1), road trafcinjury was the tenth leading

cause of deaths in the

Region responsible for 2%

of all causes of mortality.

The study also revealed

that road trafc injury was

the leading cause of mortality due to

injury, accounting for 18% of injury-

related mortality (Figure 1).

Every hour 40people in the

South-East AsiaRegion die as a

result of roadtrafc injuries


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In many South-East As ian

countries, a rapid increase in the

number of motorized two- and

four-wheelers, mixed traffic flows,

inadequate infrastructural safety

features, suboptimal levels of

trafc safety law enforcement, and

inadequate postcrash response are

some of the major factors responsible

for the increasing number of road

trafc injuries and deaths.

Figure 1:Injury-related mortality in the South-East Asia Region, 2004

Source: WHO, Geneva, Global Burden of Disease Study (2004 update).

Road trafc injury

prevention efforts

Preventing road trafc crashes and

injuries is an important area that calls

for the attention of policymakers

from health, transportation, police

and justiceand is particularly cost-effective. The United Nations and its

Member States have acknowledged

the need of road safety for nearly

60 years but it was only in 2004

when the World Health Organization

and the World Bank published the

World Report on Road Trafc Injury

Prevention(7) that attention was draw

to the huge toll from road traffic

injuries on the health sector and

the need to step up efforts around

the world. The Report made six

recommendations that countries

could implement in order to improve

their road safety situation at the

national level (Box 2). Subsequent

United Nations General Assembly and

World Health Assembly resolutions

urged countries to implement these

recommendations. Following the

launching ofWorld Report on Road

Traffic Injury Prevention, several

resolutions have been adopted by


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the UN General Assembly and one

by the World Health Assembly which

endorsed the recommendations of the

Report (Box 2).

Box 2: Recommendations of the World Report on

Road Trafc Injury Prevention

Identify a lead agency in government to guide the national road trafc safety1.

effort.

Assess the problem, policies and institutional settings relating to road trafc injury2.

and the capacity for road trafc injury prevention in each country.

Prepare a national road safety strategy and plan of action.3.

Allocate nancial and human resources to address the problem.4.

Implement specic actions to prevent road trafc crashes, minimize injuries and5. their consequences, and evaluate the impact of these actions.

Support the development of national capacity and international cooperation.6.

Source: Peden M., et al., eds. World Report on Road Trafc Injury Prevention. Geneva, Switzerland,World Health Organization, 2004.

Transport Min is ters of the

Associat ion of South-East Asian

Nations (ASEAN) gathered in Phnom

Penh, Cambodia, on 23 November

2004 for the 10th ASEAN Transport

Ministers (ATM) Meeting. The meeting

concluded with a declaration on

raising safety standards on ASEAN

roads (2004 Phnom Penh Ministerial

Declaration on ASEAN Road Safety).

Since three of the participating

countries (Indonesia, Myanmar and

Thailand) were members of ASEAN,

this Declaration would have had a

positive impact in drawing the policy-

makers attention. However, another

Declaration on improving road safety in

Asia and the Pacic was made during

the meeting of senior government

ofcials (Ministerial Conference on

Transport) in 2006 in Busan, Republic

of Korea. The Declaration invites the

members and associate members

of the Commission to implement the

recommendations contained in the

World Report on Road Trafc Injury

Prevention in line with UN General

Assembly resolut ion 60/5 of 26

October 2005 on improving global

road safety.

Although, several initiatives have

been taken in different parts of theglobe by a number of national and

internationals organizations, including

the United Nations, to improve the

road trafc injury situation, road trafc

injuries continue to be a neglected

public health problem in most Member

States of the WHO South-East Asia

Region.


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As more countries continue to take

steps towards addressing their national

road safety problem, regular global as

well as regional assessments of road

safety are needed. Such assessment

requires a standardized methodology

that can provide governments, donors,

practitioners, planners and researchers

with the information that they need to

make evidence-based decisions.

In August 2007 WHO began todevelop the Global Status Report on

Road Safety (GSRRS) to address

this data gap and assess road

safety around the world. The specic

objectives of the project were:

to assess the status of road

safety in all WHO Member States

using a core set of road safety

indicators and a standardized

methodology;

to indicate the gaps in road

safety; and

to help countries identify the key

priorities for intervention, and to

stimulate road safety activities at

the national level.

The need for

situation analysis 2Using the data collected for this

global initiative and published in the

Global Status Report on Road Safety:

Time for Action(2), this regional report

on status of road safety for the

South-East Asia Region explores

the magnitude of road trafc injuries

and efforts to address the problem

in the Region. Most Member States

are still at the incipient stage of

addressing the problem and hence

this assessment is essential to

provide baseline data and specic

recommendations so that progress

at a national level within the Region

can be measured over time.

Methodology

A self-administered questionnaire

was developed by WHO using therecommendations of the World Report

on Road Trafc Injury Prevention as

the basis for its structure and content

to gather information on the status

of road safety in all WHO Member

States. The questionnaire addresses

the following areas:


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National set up and policy (lead

agency for road safety activity,

national strategy on road safety

and funding).

Data (road traff ic deaths/

injuries and costs of road trafc

injuries).

Exposure to risk (number of

registered vehicles, national

policies to encourage non-

motorized modes of transport and

to support public transport).

Infrastructure and vehic le

standards (road safety audit,

manufacturing standard and

vehicle inspection).

L e g i s l a t i o n ( s o m e m a i n

behavioural risk factors, e.g.

speed, drink-driving, motorcycle

helmet use, seat-belts and use of

child restraints, and perception

of enforcement levels of this law

by the respondents).

Postcrash care (existence of

formal publicly available pre-

hospital care system and

universal access phone number

for pre-hospital care).

The questionnaire was used to

collect data from 10 of the 11 Member

States of the South-East Asia Region.

In each country a National DataCoordinator (Table B.1 in the Statistical

Annex) was recruited to coordinate

the data collection process, facilitate

the consensus meeting to finalize

country data, obtain approval from

the relevant government authority for


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using country data in the global as well

regional report, and enter the country

data into the database set up for this

project. Before starting data collection

at the country level all National Data

Coordinators were provided with

training on the methodology and tools

for collection.

The National Data Coordinators in

each country worked closely with the

WHO country ofces and Regional

Office to identify respondents for

the consensus meeting (Table B.2in the Statistical Annex). In some

countries National Data Coordinators

directly communicated with the

relevant ministries and institutes

to identify respondents. Since the

questionnaire covers a broad range of

road safety issues; participants from

the following sectors were identied

as the respondents to adequatelyanswer the range of questions:

M i n i s t r y o f H e a l t h / D e p t

responsible for public health;

Ministry of Transport/Ministry of

Highway;

Ministry responsible for law

enforcement/police;

National statistics ofce;

Academics having experience

in road trafc injury research;

and,

Nongovernmental organizations

i n v o l v e d i n r o a d s a fe t y

activities.

In the South-East Asia Region,data collection began in April 2008

and was completed in June 2008.

All Member States of the South-

East Asia Region except DPR Korea

participated in the survey. Each

respondent was asked to complete

the questionnaireindependently and

then invited to discuss the answers

to each question at the consensusmeeting where they would agree

as a group on one final country

response. This was then submitted

to WHO SEARO, except in the case

of Timor-Leste where the National

Data Coordinator along with Regional

Data Coordinator interviewed the

respondents.

Thereafter, the Regional Data

Coordinator and National Data

Coordinators validated all data based

on supporting documents (Figure 2).

The nal data set was then sent to

the respective country for clearance/

approval through the relevant

government authority. All data were

analysed by WHO headquarters with

sub-analyses conducted in SEARO.

We have considered the modelled

data to avoid denition-related bias

in calculating death rates.


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Figure 2:Methodology of the survey


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Road trafc injuries: An

epidemic in the Region

According to the results of

this survey, approximately

288 768 people were killed

on the roads in 102 of the

11 countries of the WHO

South-East Asia Region

in 20073. Almost 73% of

2 DPR Korea did not take part in the survey.

3 Reported data were adjusted to reecta 30-day denition of road trafc death.Underreporting issues were taken intoconsideration during managing the global

this burden belongs to India, which

accounts for approximately 66% of

the Region's population. However,the highest mortality rate

per 100 000 population

was observed in Thailand

( 2 5 . 4 ) , f o l l o w e d b y

Myanmar (23.4) and

Maldives (18.3) (Table 2).

data and a statistical model using negative

binomial regression was developed andapplied to those countries with known poor

vital registration systems (see StatisticalAnnex).

Road trafc injury

scenario 3

An estimated288 768 people dieddue to road trafc

injuries in theSouth-East AsiaRegion in 2007.


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Table 2: Road trafc deaths (per 100 000 population) in 10 countries ofthe South-East Asia Region (using modelled data), 2007*

CountryPopulationa

Reportednumber

ofdeathsb

Modelled number of deathsc Estimated roadtrafc death

rate per 100 000populationc

Pointestimate

90% condence

interval

Bangladesh 158 664 959 4 108 20 038 14 88229 155 12.6

Bhutan 658 479 111 95 72115 14.4

India 1 169 015 509 105 725 196 445 155 727266 999 16.8

Indonesia 231 626 978 16 548 37 438 29 78565 158 16.2Maldives 305 556 10 56 37105 18.3

Myanmar 48 798 212 1 638 11 422 6 90516 883 23.4

Nepal 28 195 994 962 4 245 3 4535 288 15.1

Sri Lanka 19 299 190 2 334 2 603 2 1853 097 13.5

Thailand 63 883 662 16 240 16 240 - 25.4

Timor-Leste 1 154 775 49 186 143255 16.1

(Source: Government approved data from the participating countries)

* Except Bangladesh (2006), Bhutan (mid 2006-mid 2007) and India (2006). Indian data for 2007 isavailable.a Population Division of the Department of Economic and Social Affairs of the United NationsSecretariat (2007). World population Prospects: The 2006 Revision, Highlights. New York: UnitedNations.b Adjusted for 30-day denition of a road trafc death.c Modelled using negative binomial regression (see http://www.who.int/violence_injury_prevention/road_safety_status/methodology/en/index.html for detailed methodology).

Most countries in the

Region have begun to

collect data on road trafc

death routinely over thelast decade. It is evident

from the available data

on trends in road trafc

deaths from countries that

there is a perceptible rise in cases

of road trafc deaths in Bangladesh,

Indonesia and Myanmar, as well as

in India (Table A.1 in the

Statistical Annex). A slight

downward trend in deaths

has been observed inThailand in the past few

years (Figure 3).

Males in all countries

of the Region are almost three times

more likely to die due to road trafc

accidents than females (Figure 4).

Males are almostthree times more

likely to be victimsof road trafc deathsthan females in the

South-East Asia


26/105


Figure 3:Road trafc deaths rate (per 100 000 populationa)trends in the South-East Asia Region

(using actual data updated from countries), 1995 - 2007

(Source: Government approved data from the participating countries.)

a Populations of the respective year have been cited from the Population Division of theDepartment of Economic and Social Affairs of the United Nations Secretariat, World PopulationProspects: The 2008 Revision, http://esa.un.org/unpp.

Figure 4:Road trafc deaths in nine countries of theSouth-East Asia Region, classied by sex, 2007*


* Except Bangladesh (2006), Bhutan (mid-2006 mid-2007) and India (2006). Indian data for 2007is available.

0 10 20 30 40 50 60 70 80 90 100

Thailand

Sri Lanka

Nepal

Myanmar

Maldives

Indonesia

India

Bhutan

Bangaladesh

Percentage

Male

Female


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Reported data on road traffic

injuries is known to underestimate the

true extent of the road safety problem

in many countries, particularly in low-

income ones. Participating countries

provided information on road trafc

deaths from different sources

mainly the policewhich are known

to underreport (Box 3). Besides,

variations among the countries in

defining what constitutes a road

trafc death were observed4. Thus,

a number of underreporting issues,

including variations in dening death,

4 Deaths at the scene of crash are consideredas fatal cases in Bangladesh and Maldives.In Nepal, died within 35 days of a crashare recorded as fatal cases. The rest of the

countries use standard denition of death(died within 30 days of crash) to recordfatal cases. Although there is no standard

denition in Timor-Leste, at the consensusmeeting all respondents agreed that died

within a week following a crash could beconsidered as a fatal case.

were taken into consideration at the

time of managing the global data.

Hence, a statistical model was

developed (using negative binomialregression) and applied to those

countries with known weak vital

registration systems (completeness

less than 85%) or with more than

30% of deaths undefined (see

Explanatory Notes on Page 46).

We have considered the modelled

data to avoid denition-related bias

while calculating death rates. Forinstance, the actual number of deaths

in Bangladesh was 4108 (on spot)

but the modelled number is 20 038

ranging from 14 882 to 29 155, the

number of road trafc deaths (30-

day denition) reported by India was

105 725 but the modelled number

for India is 196 445 with a range of

155 727 to 266 999.

Box 3: Police record is grossly underreported in the Region:A report from Nepal

Underreporting of road trafc deaths and injuries is a critical issue in the South-East

Asia Region. Availability of reliable, accurate and valid data is fundamental in preventing

road trafc injuries.

A study conducted in Nepal revealed that compiling the accurate number of road

accidents is difcult. Only those accidents with severe degree of injury or propertydamage or with accompanying disputes are reported and recorded by the police.

The total number of road trafc accidents in Nepali (Year 2062-63 (2006)) was 1752.

Of these 102 cases were fatal, followed by 345 serious injuries. However, long-term

effects of accidents are not recorded by the Valley Trafc Police. Hence, the police

report on road trafc injuries does not reect the actual scenario.

Source: Joshi S.K.. Injuries in Nepal: A growing public health problem. Kathmandu University Medical

Journal, 2007.5(1):2-3


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In addition, road traffic injuries

data are largely underreported due to

classication and coding errors as wellas poorer reporting processes. For

example, Maldives has no nationwidesystem to record road trafc injuries data

(Table A.2 in the Statistical Annex).

Injury data could not be analysedand compared since the data provided

by the participating countries is from

different years and sources. However,

the ratio between death and injury in

the available data was 1:5, which is

not similar to the previous estimatesat the global as well as regional level

(the Global Status Report on Road

Safetyshowed a ratio

of 1:20 between deaths

and severe injuries).

A study conducted

in Delhi revealed that

the rates of morbidity;disability and mortality

per 1000 populationdue to road traff ic

injuries were 18.5, 3.4 and 0.4respectively(8) while global data

showed that for lifetime exposure,the average person in a developed

country has a 1% risk of death and

a 30% risk of injury(9). Probablythe vast difference in ratio is due to

gross underreporting of injury data.

For instance, for the country prole,Bangladesh provided injury data

from a national survey and not from

the government records to offset the

underreporting issue.

Vulnerable road users

Data from this survey show thatin the South-East Asia Region

vulnerable road users (pedestrians,motorcyclists and cyclists) make

up the h ighest proport ion of

reported deaths. However, there is

considerable variability among the

various participating countries. For

instance, over 89% of those killed onthe roads in Indonesia are vulnerable

road users while the corresponding

gures for Thailand and Myanmar

are are 80% and 51% respectively.In India, Indonesia, Maldives andThailand, drivers and passengers of

motorized two-wheelers

account for the bulk of

the most vulnerable road

users, while pedestrians

make up this group in

Bangladesh and Myanmar

(Figure 5).

Vulnerable road users

in the Region are at

additional risk as their needs have

not been taken into consideration

by policy-planners (Box 4). Nocomparison between countries was

made because of differences in

source of data. For instance, the datafrom Bangladesh, India and Myanmar

are from the relevant government

authority while data from Maldivesand Sri Lanka are from the police and

in the case of Thailand it is from the

national injury surveillance system.

Box 4: Poor road engineering: a major risk factor

Poor road and land-use planning often leads to a deadly mix of high-speed through

trafc, heavy commercial vehicles, motorized two-wheelers, pedestrians and bicyclists

on developing-country roads. Accommodation for vulnerable road users, such as

sidewalks and bicycle lanes, are rare.

Almost three quartersof road trafc deaths

in the South-East Asiaare of vulnerable roadusers (motorcyclists,

pedestrians and

cyclists).


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Figure 5:Road trafc deaths in seven countries of the South-East AsiaRegion, classied by road user group, 2007*


* Except Bangladesh (2006), Bhutan (mid 2006-mid 2007) and India (2006). Indian data for 2007 isavailable.a Total proportion furnished was less than 100%. Since this is ofcial data 10.8% of unspeciedwas added so that the gures totalled 100%.

Data on economic cost

This analysis was done to determine

the economic burden incurred by

road traffic injuries and deaths in

the Region. Most of the people killed

on the roads are young and aged

between 15 and 44 years, which

corresponds to the most economically

productive segment of the population.

Hence, road trafc injuries pose a

huge economic burden on countries

in the Region. Seven out of ten

participating countries have at least

one study on the cost of road trafc

injuries. Gross output methodology5

5 Gross output is an economic concept usedin national accounts such as the United

Nations System of National Accounts

(UNSNA) and the US National Income andProduct Accounts (NIPA). It is equal to the

was commonly used to calculate the

cost in all countries except Thailand.

Thailand followed the human capitalmethod6 to analyse the cost of

road trafc injuries (Table A.3 in the

Statistical Annex). However, this

study did not attempt to quantify the

economic impact of road trafc injuries

on families which is also an important

issue in the SE Asia Region.

value of net output or GDP (also knownas gross value added) plus intermediateconsumption.6 Human capital/lost wages method is basedon neoclassical economic theory. Lost

product is the value of the wages (measuredas average earnings) plus other inputs toproduction (capital, plant and equipment,land, enterprise, etc) multiplied by thenumber of work days missed. For reducedproductivity while working, a percentage of

this calculation is used.


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Box 5: The impact of road trafc crashes on the poorin Bangalore, India

A study undertaken by the Transport Research Laboratory commissioned by the

GRSP (Global Road Safety Partnership) focused on the involvement and impact ofroad crashes on the poor, in comparison to the non-poor, in both urban and rural

areas in Bangalore, India. Dening poverty was not straightforwardthe study relied

on ofcial denitions and consequently the poor were dened on the basis of post-

crash incomedue to the difculty in identifying household income in the ve years

preceding the survey.

The study revealed that the poor were not found to be consistently at greater risk ofroad trafc death and serious injury: Only in the rural areas of Bangalore did poverty

correlate with a higher death rate. However, what the study did reveal was that many

households which were not poor before the road trafc injury were pushed into povertyafter a crash because of loss of contribution to the household from the injured person.

In Bangalore, the majority of households reported at least one person having to give

up work or study to care for the injured. The injured poor also had a lesser degree of

job security and fewer were able to return to their previous jobs.

Registered vehicles

Huge growth of motorized vehicles

especially motorcycles in the region

has been observed

during last few years.

From the survey it

was ev iden t tha t

motorized two- and

three-wheeled vehicles

In India, Indonesia,Maldives, Nepal, Thailand

and Timor-Leste, almost70% of all registered

vehicles are motorizedtwo- or three-wheelers.

However, in Bhutan morethan half are motor cars

constituted more than 60% of the

registered vehicles in all participating

countries of the Region except Bhutan

(Table 3). Bhutan hashighest proportion

of motor cars in the

Region: about 55% of

all registered vehicles

in the country.


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Safety law exists but the

level of implementation

is suboptimal

Speed

What is known:

The speed of the vehicle is an

important determinant of injury;

the faster the vehicle is travelling,

the greater the energy inictedon the occupants during a crash

and the greater the injury.

Research on effective speed

management indicates that the

speed limits on urban roads

should not exceed 50 km/h.

However, it is imperative to give

the local or provincial decision-

makers the authority to reduce

national-level speed limits as

required. For example, speed

limits in residential areas or near

schools or roadside markets

should be brought down.

An increase of 1 km/h in mean

traffic speed results in a 3%

increase in the incidence of

injury crashes and a 4%-5%

increase in fatal crashes(10).

A 5% increase in average speed

leads to an approximately 10%

increase in crashes that cause

injuries, and a 20% increase in

fatal crashes. Pedestrians have

a 90% chance of survival when

struck by a car travelling at 30km/h or below but less than 50%

chance of surviving an impact

at 45 km/h. Pedestrians have

almost no chance of surviving

an impact at 80 km/h(11).

Passengers in a car with an

impact speed of 80 km/h are 20

times more likely to die than at an

impact speed of 32 km/h(12).

If a car suddenly stops when

travelling at 50 km/h, the human

body becomes like a pinball

bouncing off the inside of the

car. The car can also collide

with people in the car who

are wearing their safety belt,

severely injuring them.


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Enforcement of set speed limits

through radar guns and police

presence has lowered crash

deaths by 14% and injuries by

6%(13).

The well-publicized use of

speed cameras has also been

shown to reduce crashes sub-

stantially(14,15).

What this survey found:

All participating countries except India

have speed limit legislation for cars at

a national level (Table 4). India has

only state-level legislation on speed

limits that may be modied by local

authorities7. However, national speed

7 Due to the structure of the questionnaire,India was not required to supply informationregarding state-level speed limits.

limits for urban roads is set at 50 km/h

or less in all other Member countries

except Indonesia and Thailand. Local

authorities in Indonesia, Myanmar

and Thailand have the authority to

modify national speed limits.

Hence, only 10% of participating

countries have speed limits of 50

km/h or below on urban roads and

they allow local authorities to modify

national speed limits. It was also

observed that speed limits for urban

and rural roads are different in allparticipating countries and this limit

varied according to vehicle type.

No country in the Region rated

the degree of enforcement of speed

limit laws at higher than 5 on a scale

of 0 to 10 (Table 4). This suggests

that enforcement is frequently found

lacking in the Region.

Table 4: National speed limits (km/h) for vehicles and enforcement levelsin nine countries of the South-East Asia Region, 2008

CountryUrban(km/h)

Rural(km/h)

Inter-city/highways (km/h)

Law enforcement on a scaleof 0 to 10 (as per consensus

of the respondents)

Bangladesh 25 40 60 0

Bhutan 30 50 50 3

Indiaa 4

Indonesia 70 100 100 3

Maldives 30 30 60 5

Myanmar 40 40 80 5

Nepal 40 5

Sri Lanka 50 70 5

Thailand 80 90 120 2

Timor-Leste 50 90 120 0

(Source: Government approved data from the participating countries.)a India does not have a national speed limit. However, there are state-level speed limits.

No data available.


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What needs to be done?

Reset the national as well as local/

provincial speed limits keeping

in mind road infrastructure andvulnerable road-users.

Speed enforcement detection

devices, especial ly speed

cameras, can be put in place

where required.

Local or provincial administrations

need to be given the authority,

resources and political support to

modify the national speed limits

where vulnerable road users are

particularly at risk.

Behaviour change comm-

unication programme can be

implemented to raise public

acceptance levels on enforcing

speed limits.

Alcohol

What is known:

Crash risk at a blood alcohol

concentration (BAC) of 0.05 g/

dl is 1.83 times greater than at

zero BAC(16).

Laws which establish lower BACs

(between zero and 0.02g/dl) foryoung/novice drivers can lead to

reductions of between 4% and

24% in the number of crashes

involving young people(17).

Sobriety checkpoints and random

breath-testing have been found

to lower alcohol-related crashes

by about 20%(18) and an effective

way to deter drunk driving is to

raise drivers perceived risk of

getting caught(19).


All participating countries in the Region

except Indonesia and Maldives have

legislation on drinking and driving.

However, standard methods fordening drink-driving have not been

stipulated in Bangladesh and Nepal.

Only three countries have a drink-

and-drive law that uses a BAC limit

of less than or equal to 0.05g/dl, as

recommended by the World Report

on Road Traffic Injury Prevention.

Among the participating countries the

maximum BACs are different (Table 5).Although young or novice drivers are at

a much increased risk of having a road

trafc crash when under the inuence

of alcohol, there is no special BAC

limit for them in any country. Thailand

is the only country in the Region to

have data on the alcohol-relatedness

of road trafc deaths, estimated to be

34.8% in 20078

.

8 Based on sentinel surveillance; includesdeaths in hospitals only. The original gure(4%) submitted to the study and publishedin the Global Status Report on Road Safety.

Ofcially the Thai government has requestedthat the gure be changed instead.


35/105


Box 7: Alcohol and road trafc injuries:Experiences from South-East Asia

Alcohol impairs judgement and increases the possibility of involvement in other high-

risk behaviours (e.g. speeding, violating trafc rules, etc.). It also affects vision andposes difculties in identifying risks and perceiving dangerous situations in the road

environment. Several studies conducted in India, Nepal and Sri Lanka showed that asignicant number of road trafc injuries are contributed by alcohol.

In Sri Lanka, the number of people riding vehicles under the inuence of alcohol

increased from 1494 in 1984 to 5667 in 1999. Information from the police also indicated

that more than 10% of drivers were under the inuence of alcohol. It was also observed

from a study that 12% of all patients admitted to the emergency departments of hospitalsfollowing road trafc injuries had been under the inuence of alcohol.

Jha et al. in a hospital-based study in Nepal found that most of the road trafc injuriesoccurred during weekends and nearly 17% of these accidents occurred because the

driver was under the inuence of alcohol.

A hospital-based study conducted in casualty departments in India revealed that 7% ofroad trafc injury patients had consumed alcohol. Another study also found that 29%

of two-wheeler victims had been under the inuence of alcohol.

Source: Gururaj G. Alcohol and road trafc injuries in South Asia: Challenges for prevention. Journal

of College of Physician and Surgeon Pakistan, 2004; 14(12): 713-718

Table 5: Blood alcohol concentration (g/dl) stipulated in 10 countriesof the South-East Asia Region, 2008

Country General populationYoung/novice

driversProfessional/

commercial drivers

Bangladesha

Bhutan 0.08

India 0.03

Indonesiab

Maldivesb

Myanmar 0.07

Nepala

Sri Lanka 0.08 0.08 0.08

Thailand 0.05 0.05 0.05

Timor-Leste 0.05 0.05 0.05

(Source: Government approved data from the participating countries.)aDrink-driving law exits but no standard denition or no national blood alcohol concentration limit.bNo drink-driving law.

No data available.


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Table 6: Mechanisms for enforcing drink-driving laws andlevel of enforcement in the select Member countries

of the South-East Asia Region, 2008

CountriesRandomBreath-testing

Police checkpoints

Breath-testingof all driversinvolved in

crashes

Blood testingof all driversinvolved in

crashes

Lawenforcementon a scale of

0 to 10

Bangladesh No No No No 1

Bhutan No No Yes Yes 3India Yes Yes Yes Yes 3

Myanmar Yes No No No 5

Nepal Yes Yes Yes No 6

Sri Lanka Yes Yes No No 5

Thailand Yes Yes No No 5

Timor-Leste Yes Yes No No 0



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Random breath-testing and

police checkpoints are important

enforcement mechanisms that have

been shown to reduce alcohol-

related crashes. Three quarters

of the countries reported that they

use one or both of these methods

to enforce the law However, the

degree of enforcement appears to be

unsatisfactory. Nepal and Sri Lanka

rated the enforcement of their drink-

driving law at 6 on a scale of 0 to 10

while all other countries rated it at 5

or less (Table 6).


All Member States should have

and should strictly enforce the

law on drink-driving with clear

definitions and blood alcohol

concentration (BAC) limits set

at or below 0.05g/dl.Special BAC limit (below 0.02g/dl)

should be set for the young or

novice drivers in all Member

States.

Behaviour change comm-

unication programme can be

implemented to raise public

awareness leve ls on the

magnitude of drinkdriving and

the reasons for enforcing the

law.

Helmets

What is known:

Head injury is the major cause of

hospital admissions and deaths

among riders of motorized two-

wheelers and bicycles(20,21).

Among motorized two-wheeler

riders it has been found that in acrash no-helmets users are three

times more likely to sustain head

trauma than helmet-users(22).

Wearing a motorcycle helmet

correctly can reduce the risk of

death by almost 40% and the

risk of severe head injury by over

70%(23).

When motorcycle helmet laws

are enforced effectively, helmet-

wearing rates can increase to

over 90%(24).

Mandatory helmet laws reduce

head injuries among cyclists by

about 25%(13).


Drivers and passengers (both adult

and child) of motorized two-wheelers

are required by law to use helmets

in all participating countries of the

Region except Maldives. This law

also applies to all road types and

vehicles of all engine sizes. However,

four countries have exceptions for

religious reasons and Sri Lanka doesnot enforce the wearing of helmets

among children going to school in

uniform (Table 7). In addition, only

six of the participating countries

stipulate that helmets need to meet

a specic standard. Effectiveness of

enforcement of the existing helmet

law is satisfactory (greater than or


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equal to 6) in several participating

countries compared to enforcement

levels of other road traffic injury

prevention laws (Table 7). Taken

together these ndings reveal that

countries in the Region are making

a progress towards implementing the

law on wearing helmets. However, the

effectiveness of enforcement of helmet

laws is quite low in Bangladesh, India,

Thailand and Timor-Leste.

Box 8: Mandatory helmet use law reduceshead injuries signicantly in Thailand

In Thailand, mortality due to trafc injuries began to increase in the late 1980s. According

to hospital data, approximately 80% of all road trafc injury victims are motorcyclists

and about half had had head injuries. To reduce motorcycle-related deaths, the Act on

wearing of helmets for motorcyclists was enacted nationwide in Thailand in December1994 and was subsequently enforced. Trauma registry data (two years before andafter the enforcement of the Helmet Act) at the Khon Kaen Hospital were analysed to

evaluate the effectiveness of the law. It was found from the study that after enforcement

of the Act, the number of motorists wearing helmets increased ve-fold while head

injuries decreased by 41.1% and deaths by 20.8%.

Source: Ichikawa M, Chadbunchachai W, Marui E. Effect of the Helmet Act for motorcyclists in Thailand.

Accident Analysis and Prevention, 2003, 35:183-189.

Table 7: Helmet-wearing laws and enforcement in theSouth-East Asia Regiona, 2008

CountryExistenceof helmet

lawExemptions

Requireshelmet

standards

Law enforcementon a scale of

0 to 10

Bangladesh Yes No No 3

Bhutan Yes No Yes 9

India Yes Religious headgear Yes 2

Indonesia Yes Religious headgear Yes 7

Maldives No n/a n/a n/a

Myanmar Yes Religious headgear Yes 6

Nepal Yes No No 9

Sri Lanka Yes Schoolchildren in uniform Yes 7

Thailand Yes Religious headgear Yes 4

Timor-Leste Yes No No 5

(Source: Government approved data from the participating countries.)aDPR Korea did not participate in the survey.

n/a: Not applicable.


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Indonesia, Myanmar and Thailand

have a national estimate on the

proportion of helmet use among riders

of motorized two-wheelers though the

reliability and the generalizability of

the results vary considerably. More

than 93% of motorized two-wheeler

riders use a helmet in Indonesia, 60%

in Myanmar and only 27% in Thailand.Although there is no national estimate

for Timor-Leste respondents at the

consensus meeting agreed that

approximately 70% of all motorized

two-wheeler drivers in that country

used helmets.


All Member States should have law

on mandatory helmet use by the

driver and passengers of all engine

types of motorized two wheelers

and enforce strictly to obtain

substantial impact in reducing

deaths and head injuries.

Motorcycle helmets should

meet a national or international

standard and should be available

for all population, and especially

for children.

Member States should develop

system to collect data to monitor


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helmet-wearing rate and use

it as a police performance

indicators.

Seat-belts and

child restraints

What is known:

Seat-belt use reduces crash

death risk by 40%-65%, moderate

and severe injuries by 43%-65%

and all injuries from 40%-50%(25,

26).

Wearing a vehicle safety belt

reduces the risk of being killed or

seriously injured in a road crash

by about 40%.

Use of child restraints has been

shown to reduce infant crash

deaths by about 71% and the

deaths of small children by

54%(27).Mandatory child restraint laws

and their enforcement lead to

an increase in the use of child

restraints(28,29).


While seat-belt laws are widespread

in other Regions of WHO only six

countries in the South-East Asia

Region have formulated national

laws on seat-belt use (Table 8). In

three of these countries (Bhutan,

India and Timor-Leste) the law is

applied to both front- and rear-seat

occupants while in the other three

countries the law is only applicable

to front-seat occupants. Indonesia

has the highest rating of seat-belt law

enforcement (7 on a scale of 0 to 10)

in the Region. Other countries have

a law enforcement rating of 5 or less

on the said scale.

According to the behavioural risk

factor surveillance system of the Bureau

of Noncommunicable Diseases,

Ministry of Public Health, Thailand,

56.4% of all front-seat occupants

use seat-belts. Although there is no

national data on the proportion ofseat-belt users in Indonesia, a survey

in Jakarta showed that 85% of all car

occupants use seat-belts. During the

consensus meeting in Timor-Leste it

was estimated that about 5%-10% of

front-seat occupants use seat-belts.

In other countries there was no data

on the proportion of seat-belt users

among motorists at a national level.

Seat-belt laws cannot be effective

if large numbers of cars are not

tted with seat-belts. Among the car

manufacturing countries in the Region,

Indonesia has seat-belt installation

standards for both seats. However,

India and Thailand have seat-belt

installation standards applicable onlyfor the front seats.

Use of child restraints is mandatory

in Timor-Leste as per government

decree (Decree law No. 06/2003,

Section 55). In other Member

countries, there is no law on the use

of child restraints.


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Table 8: Seat-belt and child restraint laws in theSouth-East Asia Regiona, 2008

Country

Seat-belt

law exists

Applies to all

occupants

Law enforcement

on a scale of0-10

Child-restraint

law exists

Bangladesh No n/a n/a No

Bhutan Yes Yes 4 No

India Yes Yes 2 No

Indonesia Yes No 7 No

Maldives No n/a n/a No

Myanmar No n/a n/a Dont know

Nepal Yes No 4 No

Sri Lanka No n/a n/a NoThailand Yes No 5 No

Timor-Leste Yes Yes 0 Yes

(Source: Government approved data from the participating countries.)aDPR Korea did not participate in the survey.


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Car manufacturing countries in

the Region should have seat-

belt installation standards forboth front and rear seats of all

vehicles.

All countries should enact laws

that require car occupants of

both front and rear seats to use

seat-belts.

Strengthening the enforcement

of the law for occupants of both

front and rear seats of cars.

All Member countries should pass

child restraint laws specifying

the type of restraint, the childs

age for which each restraint is

appropriate, and the seating

position.

Improve access to affordable

child restraints.

Countries need to establish

systems to collect data on rates

of use of seat-belts and child

restraints.

Enforcement efforts must be

supplemented by raising public

awareness on wearing a seat-belt

and using child restraints through

mass media campaigns.

Synopsis of

legislative issues

While positive steps towards the

enacting of appropriate legislation

have been taken in most participating

countries, much remains to be done.

Governments need to enact and

enforce comprehensive laws that will

save thousands of lives from road

trafc injuries.

All participating countries reported

at least one law related to the ve

major risk factors (speed, drink-

driving, helmets, seat-belts and child

restraints) at the national or sub-

national level, although these are not

entirely comprehensive in scope. Only

Timor-Leste has national laws relatingto all risk factors while Bhutan, India,

Nepal and Thailand have laws on four

major risk factors (with the exception

of the use of child restraints). Laws

need to ensure that legal loopholes

that could exempt particular groups

of road-users are plugged. Existing

laws also appear to be inadequately

enforced in most countries.

Enforcement efforts must be highly

visible, well-publicized, sustained,

and implemented by appropriate

measures and with accompanying

penalties for infringement. Effective

enforcement of these laws depends

on police performance and public

support.

Pre-hospital care system

Many road traffic deaths may be

prevented or their severity reduced by

adequate pre-hospital trauma care.

However, pre-hospital care is virtually

non-existent in most countries of the


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South-East Asia Region. The major

benefits of pre-hospital care are

realized when the timely provision of

care can limit or halt the cascade of

events that otherwise lead quickly to

death or lifelong disability. Mortality

is related to at least four major

variables: severity of the injury, host

factors, quality of care, and elapsed

time before denitive treatment. Pre-

hospital trauma care could inuence

the survival rate of trauma patients

by providing rst aid at the scene

of crash, transferring patients to the

appropriate hospital, as well as by

reducing transfer time(31).

Table 9: Nationwide universal access phone number in participatingcountries* for pre-hospital care system, 2008

CountryFormal pre-hospitalcare system in

existence

Nationwide universalaccess phone number

for pre-hospital care

Regional or local accessphone numbers for

pre-hospital careBangladesh No

Bhutan Noa 112

India Yes 102

Indonesia Yes 118- ambulance

113-re department

112-police department

1717-police SMS centre

Maldives No

Myanmar Yes No 01500005

Nepal Noa

Sri Lanka Nob No 110

Thailand Yes 1669

Timor-Leste Yes 110

112


* DPR Korea did not participate in the survey.aThere is no formal pre-hospital care system in Bhutan but a free ambulance service is available.In Nepal almost all ambulances are free with some exceptions.bOnly in some major cities in Sri Lanka but not nationwide.


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Data from participating countries

revealed that six of them have

either a national or regional formal,

publicly available pre-hospital care

systems (Table 9). Although there is

no formal pre-hospital care system in

Bhutan and Nepal a free ambulance

service is available in both countries.

Among the countries with pre-hospital

care facilities, Myanmar has only a

regional-level access phone number

for pre-hospital care whereas other

Member countries have nationwide

universal access phone numbers for

pre-hospital care.

All participating countries have

the institutional framework for

road trafc injury prevention

All participating countries in the South-East Asia Region have a lead agency

to address road trafc injuries (Table

10). In most of the countries, lead

agencies are part of a government

ministry, mostly the ministry of

road, transport and highways. Inter-

ministerial bodies serve as the lead

agency in Bangladesh, Myanmar and

Thailand while the National Cabinet ofIndonesia is the lead agency in that

country. In seven countries funding

is available for the lead agencies to

carry out road-safety activities.

Table 10: Road safety management in the South-East Asia Region*, 2008

CountryA lead agency is

presentHas a national

strategy

Strategy hasmeasurable

targets

Strategy isfunded

Bangladesh Yes (inter-ministerial) Yes Yes No

Bhutan Yes (within agovernment ministry)

No n/a n/a

India Yes (within agovernment ministry)

Yesa n/a n/a

Indonesia Yes (NationalCabinet)

Multiple strategies n/a n/a

Maldives Yes (within agovernment ministry)

Yes Yes Yes

Myanmar Yes (Inter-ministerial) Yes Yes Yes

Nepal Yes (within agovernment ministry)

Yesa n/a n/a

Sri Lanka Yes (within agovernment ministry)

Yesa n/a n/a

Thailand Yes (Inter-ministerial) Yes Yes Yes

Timor-Leste Yes (within agovernment ministry)

Multiple strategies n/a n/a


*DPR Korea did not participate in the survey.aNot formally endorsed by government.


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Four countries in the Region have

a national strategy for the prevention

of road trafc injuries with measurable

targets formally endorsed by the

government. In these countries,

except for Bangladesh, there is

funding to carry out activities under

the national strategy. While Indonesia

and Timor-Leste have multiple

strategies, Bhutan has no national

strategy. However, seven of the 10

countries surveyed (except India,

Nepal and Timor-Leste) have included

measurable targets in their national

road safety strategy irrespective of

government endorsement.

Other measures to reduce

exposure and prevent

road trafc injuries

Reducing exposure to the risk of

injury or death on the road can be

achieved by reducing the volume

of traffic on the road as well as

behavioural change of the road users.

This in turn requires considerable

investment in infrastructure that

allows pedestrians and cyclists to

walk and cycle safely and ensure

the availability of affordable and

safe public transport. This survey

found that India, Indonesia and

Myanmar have national or local

policies to promote walking and

cycling as an alternative to motorized

transport. However, Thailand has the

same policy at the provincial and

municipal level. All these countries

have made investments to construct

exclusive bicycle lanes and footpaths.

The Government of Myanmar runs

a special programme to support

increased use of bicycles for transport.

The governments of India, Indonesia,

Myanmar, Sri Lanka and Thailand


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The previous chapter has discussed

in detail the magnitude of road trafc

injuries and the existing legislation

related to the major key risk factors

(speed, drink-driving, helmets, seat-

belts and child restraints) as well as

the rate of implementation of these

laws in Member States of the WHO

South-East Asia Region. Furthermore,

government initiative towards reducing

road traffic injuries, including the

promotion of use of alternative

transport, was also highlighted.

This chapter brings together the

major and outstanding ndings, and

the strengths and weaknesses of this

survey. The chapter concludes by

presenting a set of feasible options

or suggestions that governments and

others involved in the field of road

trafc injury prevention should consider

to develop national or local strategic

guidelines to address the problem.

This survey has provided the

rst comprehensive assessment of

road safety status in the South-East

Asia Region. The methodology of

Conclusions and

recommendations 4the survey was designed to bring

multisectoral road safety practitionerson to the same platform with the aim

of fostering collaborative efforts at

the national level. However, as with

any study, there are a number of

limitations, namely:

Information collected for this

survey was based on self-

administered questionnaires,

which is subject to potentialbiases. Furthermore, a degree

of subjectivity was introduced as

respondents were asked to rate

enforcement ofw the legislations

on risk factors in their country

according to their perception.

Cross-country comparisons for

some indicators couldnt be

made due to:

unavailability of data related

to the magnitude of the

problem. For instance,

Bhutan and Maldives have

no national data on road

trafc deaths classied by

type of road-users;


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unavailability of data on

legislation related to major

risk factors (e.g. Indonesia

and Maldives have no data

on drink-driving);

different interpretations

o f te rms used in the

questionnaire (e.g. what

constitutes a rural road or a

highway may differ between

countries);

data representing the period

are different (2003-2008);

there are different sources of

data for the same variables

(e.g. data on deaths in some

countries came from the

police sector and in others

from the health sector. In

the case of Bangladesh

the national survey was the

source of injury data whereas

other countries provided the

same data from either the

health sector or the police);

and,

unavailability of data related

to monitoring and evaluation

indicators such as rate

of seat-belt use and the

use of helmets and child

restraints.

T h e s u r v e y f o c u s e d o n

national-level data, but in a few

participating countries legislation

related to major key risk factors

are enforced at the sub-national

or local level (e.g. in India each

state has its own law on speed

limit). Besides, local authorities

are entitled to modify national-

level legislation. This survey did

not record these sub-national or

local data.

Most of the countries in the

Region do not manufacture

motor cars but import them.

However, this survey did not

collect any information on seat-

belt requirements for imported

cars.

Despite its limitations, this survey

has generated information that could

be useful for policy guidance in

addressing road trafc injuries at the

national as well as regional level.

The results of this survey can

serve as an information base for

policy-makers on the magnitudeof road traffic injuries as well as

existing road safety practices in

Member States of the Region for the

purposes of setting priorities. This

survey may also be a supplementary

source of information along with other

international and national studies

and programmes; for example,

implementation and evaluation ofthe good practice manuals developed

through the United Nations Road

Safety Collaboration.

The response to road traffic

injuries cannot and should not be

different from other public health

responses. Enhancing public health


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response to include road traffic

injuries requires obtaining commitment

from professionals concerned. The

momentum of response to road trafc

injuries as a regional crisis needs

serious attention, and we must search

for more effective strategies to end the

pandemic of road trafc injuries across

the Region. The commitment from

the political leadership in countries,

and from policy-makers in WHO, the

World Bank, United Nations and the

international community has provided

a platform on which we can work

together.

This survey, however, shows that

much more remains to be done. No

country can afford to be complacent

and assume that its road safety

work is complete. The international

community must continue

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